冠状动脉病变支数及介入治疗对冠心病患者QT离散度的影响

Effects of coronary lesion vessels and interventional treatment on QT dispersion in patients with coronary heart disease

目的探讨冠状动脉病变支数及介入治疗对QT离散度(QTd)的影响。方法对72例成功进行经皮冠状动脉腔内成形和支架术的冠心病患者,计算手术前后12导联同步心电图QTd及校正后QTd(QTcd)。结果冠心病不同类型和冠状动脉病变不同支数术前QTd及QTcd无明显差别(P>0.05),术后QTd及QTcd均较术前显著下降[稳定型心绞痛、不稳定型心绞痛和急性心肌梗死QTd为(49±20)msvs(57±24)ms、(46±18)msvs(61±18)ms、(48±18)msvs(61±20)ms,P<0.05;QTcd为(56±28)msvs(68±25)ms、(56±18)msvs(71±20)ms、(59±20)msvs(69±22)ms,P<0.05];单支病变组术后QTd、QTcd较其他病变组下降显著[术后单支血管病变与2支病变、3支病变的比较为QTd(38±18)msvs(50±24)msvs(52±16)ms,F=15.86,P<0.01;QTcd(45±20)msvs(56±18)msvs(58±27)ms,F=9.60,P<0.01]。结论介入治疗前冠心病患者QTd及QTcd与受累病变血管支数无关,在介入治疗后随着心肌缺血及心室复极不均一性的改善而降低。

Objective To approach the effects of coronary lesion vessels and interventional treatment on QT dispersion(QTd) in patients with coronary heart disease. Methods Percutaneous transluminal coronary angioplasty (PTCA) and stenting were performed successfully on 72 patients with coronary heart disease. QTd and corrected QTd(QTcd) were obtained with a standard 12-lead ECG before and after PTCA + Stent. Results QTd and QTcd after PTCA + Stent were reduced significantly compared to those before PTCA+Stent[QTd(49±20) ms vs (57±24) ms in stable angina pectoris(SAP),(46±18) ms vs (61±18) ms in unstable angina pectoris(UAP) and (48±18) ms vs (61±20) ms in acute myocardial infarction(AMI),P< 0.05;QTcd(56±28) ms vs (68±25) ms in SAP,(56±18) ms vs (71±20) ms in UAP and (59±20) ms vs (69±22) ms in AMI,P< 0.01]. There were no significant differences in QTd and QTcd before PTCA + Stent between single vessel lesion and multi-vessel lesion, also in among stable,unstable angina pectoris and acute myocardial infarction, but after PTCA+Stent, QTd and QTcd in single vessel lesion were decreased significantly compared to those in multi-vessel lesion[after PTCA+stent QTd(38±18) ms in single lesion vs (50±24) ms in 2-vessels lesion vs (52±16) ms in 3-vessel lesion,F= 15.86,P< 0.01;QTcd(45±20) ms in single lesion vs (56±18) ms in 2-vessels lesion vs (58±27) ms in 3-vessels,F= 9.60,P< 0.01]. Conclusion QTd and QTcd were not associated with coronary lesion vessels before PTCA+Stent and decreased significantly after PTCA+Stent because of the improvement of myocardial ischemia and heterogeneous repolarization in patients with coronary heart disease.